Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

  • Hermann Senator
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    [Not long ago the writer was consulted by a middle-aged woman, who had apparently reached nearly the terminal stage of contracted kidney. She had been under the care of physicians for fourteen years for this trouble. From her history one might surmise that the kidney disease had had an insidious beginning some time before this. But to her certain knowledge albumin and casts had been present at every one of the frequent urinalyses made in the fourteen years.—Ed.] If physicians will develop the habit of examining the urine for albumin even in apparently healthy individuals, cases of chronic nephritis lasting a number of years will probably be more and more frequently seen. In arteriosclerotie induration the course is not quite so slow, and the duration also is shorter because the vessels and the heart, on which so much depends, have been diseased before the beginning of the renal affection. For similar reasons secondary contraoted kidney is character- ized by a more rapid course, counting from the time when the signs of induration become clearly marked. The termination of indurative nephritis, when it has reached the stage of fully developed contracted kidney, and especially when cardiac hypertrophy is pronounced, is always fatal. Death, however, does not always occur as the immediate consequence of the renal or vascular disease, being not infrequently brought about indirectly by more or less incidental complications, such as inflammation of the lungs or of the intestines, erysipelas, or the like, to which the organism, whose powers of resistance have been impaired, more readily falls a prey than under normal conditions. In other cases death is caused by uremia, hemor- rhage into the brain or some other form of hemorrhage, or by passive congestion of internal organs. In the arteriosclerotic form death may be due to softening of the brain from thrombosis, or to gangrene of the toes, or to other results of the general sclerotic change in the arteries. During the first stage of the disease, before any signs of cardiac or arterial disease are present, partial recovery is possible and is not even rare if appropriate treatment is instituted in time. This is indisputably shown by clinical observation as well as by the postmortem finding of old indurative nephritis with contraction in persons who, as has been said, had not shown any sign of kidney disease for a variable time preceding death, and this fact should be emphasized again and again in connection with the diagnosis of functional or cyclic albuminuria. DIAGNOSIS. Fully developed contracted kidney is so well characterized by the clinical picture as described by Traube—copious watery urine containing a small amount of albumin, the signs of cardiac hypertrophy and increased aortic pressure—that it cannot well be mistaken for any other condition except by a physician who is so unprogressive as not to make an examination of the urine, especially for albumin, unless dropsy is present, or to examine the heart unless the patient complains of palpita- tion and asthmatic symptoms. If the heart and kidneys are systemat- ically examined in every case, contracted kidney will not be overlooked,
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